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Loop Electrosurgical Excision Procedure

(LEEP, LLETZ—Large Loop Excision of the Transformation Zone, LLEC—Large Loop Excision of the Cervix, Loop Cone Biopsy of the Cervix)

Definition

Loop electrosurgical excision procedure (LEEP) uses a thin wire loop to cut out areas of the cervix. The cervix is the lowest part of the uterus. The Loop allows precise cuts.

Reasons for Procedure

LEEP is often done to remove abnormal cells from the cervix. These abnormal cells or cervical dysplasia are often during a pap test.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review possible problems, like:

  • Bleeding
  • Abdominal cramping
  • Infection
  • Future pregnancy problems (small increased risk of premature birth and having a low birth weight baby)
  • Incomplete removal of the abnormal tissue
  • Accidental cutting or burning of normal tissue
  • Narrowing of the cervix (rare)

The doctor will talk about ways to manage risks. Factors that can increase your risk of problems include:

The following may also increase the risk of complications:

  • Menstruation at the time of the procedure—It is best to have LEEP done when you do not have your period.
  • History of pelvic inflammatory disease
  • Inflammation of the cervix
  • Pregnancy or possible pregnancy

What to Expect

Prior to Procedure

Talk to your doctor about your medicine that you take. You may be asked to stop taking some medicine up to 1 week before the procedure.

The day of the procedure:

  • You may need to arrange for someone to drive you home from the clinic.
  • If directed by your doctor, take a pain reliever before the LEEP.
  • Bring sanitary napkins to use after the procedure.

Anesthesia

Local anesthesia is often used for a LEEP. It will numb the area but you will be awake. The anesthesia may be applied as a lotion or injected into the area.

Description of the Procedure

You will lie on your back on a table with your feet up in footrests. A speculum will be inserted into your vagina. This tool will separate the vaginal walls. This will allow the cervix to be viewed. Anesthesia will be applied to the cervix to numb the area.

A solution will be applied to the area. It will highlight abnormal cells. A thin wire will be inserted into the vagina toward the cervix. The abnormal tissue will be removed with the thin wire. The tool heats the area to stop bleeding from blood vessels. A paste may also be applied to stop bleeding.

How Long Will It Take?

LEEP only takes a few minutes.

How Much Will It Hurt?

You may feel cramping during LEEP. You should not feel any sharp pain.

Post-procedure Care

At the Care Center

You will be allowed to rest. When you are ready you can go home.

At Home

It will take a few weeks for the area to fully heal. Most can return to normal activity in a few days.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

  • Heavy bleeding (more than your normal period)
  • Bleeding with clots
  • Severe abdominal pain
  • Fever or chills
  • Unusual odor or discharge

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

The American Congress of Obstetricians and Gynecologists
http://www.acog.org

Family Doctor—American Academy of Family Physicians
https://familydoctor.org

CANADIAN RESOURCES:

Canadian Women’s Health Network
http://www.cwhn.ca

The Society of Obstetricians and Gynaecologists of Canada
https://sogc.org

REFERENCES:

American Congress of Obstetricians and Gynecologists. Management of abnormal cervical cytology and histology. Practice Bulletin. 2010; 99.

Emam M, Elnasar A, Shalen H, Barakat R. Evaluation of a sinfle-step diagnosis and treatment of premalignant cervical lesions by LEEP. Int J Gynaecol Obstet. 2009;107(3):224-7.

Loop electrosurgical excision procedure (LEEP). The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/Patients/FAQs/Loop-Electrosurgical-Excision-Procedure-LEEP. Updated July 2017. Accessed March 19, 2020.

Noehr B, Jensen A, Kjaer SK. Depth of cervical cone removal by loop electrosurgical excision procedure and subsequent risk of preterm delivery. Obstet Gynecol. 2009;114(6):1232-8.

Last reviewed September 2019 by EBSCO Medical Review Board Mary-Beth Seymour, RN  Last Updated: 3/19/2020